SHANNON DENISE CLARK CNP NPI 1881726271

NPI Information

NPI: 1881726271
Provider Name: SHANNON DENISE CLARK, CNP
Classification: Nurse Practitioner - 363LP0808X
Entity Type: Individual

Specialization: Psychiatric/Mental Health

Organization: MATRIX INTEGRATED PSYCHOLOGICAL SERVICES

PECOS Registration: Yes

Address:
2 EASTON OVAL STE 450
COLUMBUS, OH
ZIP 43219
Phone: (614) 475-9500
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Shannon Denise Clark, CNP is a psychiatric/mental health nurse practitioner in Columbus, OH with 6 years of experience. Shannon Denise Clark, CNP NPI is 1881726271. The provider is registered as an individual entity type and is a multi-specialty group.

The NPPES NPI record indicates the provider is a female.

Education
Medical School: OHIO STATE UNIVERSITY COLLEGE OF MEDICINE
Graduation Year:2018

The provider's business location address is:

2 EASTON OVAL STE 450
COLUMBUS, OH
ZIP 43219-035
Phone: (614) 475-9500
Fax: (614) 475-9821

The NPI 1881726271 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 3/12/2007 and was last updated on 12/11/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	APRN.CNP.023853	OHIO	Yes
2	3747A0650X	Technician	Attendant Care Provider	RN-253819	OHIO	No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	2716887	MEDICAID	OHIO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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